PROXIMAL GASTRIC-VAGOTOMY AND ANTERIOR SEROMYOTOMY WITH POSTERIOR TRUNCAL VAGOTOMY ASSESSED BY THE ENDOSCOPIC CONGO RED TEST

The completeness of vagotomy following proximal gastric vagotomy or an terior seromyotomy with posterior truncal vagotomy was assessed prospe ctively in 48 patients using the intraoperative congo red test. Pentag astrin (6 mg/kg) was given subcutaneously before the assessment. An en doscope was passed into the stomach and 180 ml congo red solution wash ed over the gastric mucosa. Continuing acid production was indicated b y the appearance of a black colour (pH < 3) 2 min after introduction o f the dye. A grading system was adopted where grades I and II showed l ittle black discoloration and grades III and IV showed increasing area s of discoloration indicating that further denervation was required. A ll 20 patients undergoing anterior seromyotomy with posterior vagotomy were classified as grade I. Fifteen of an initial 23 patients receivi ng proximal gastric vagotomy were grade III or IV. Following &vision o f either the right gastroepiploic nerve or the posterior vagal trunk, 22 patients improved to grade I (16) or II (six). In the subsequent fi ve proximal vagotomies, modification of the dissection produced grade I results. Anterior seromyotomy with posterior truncal vagotomy gave c onsistently complete vagotomy. The congo red test highlighted major di fferences in the adequacy of vagotomy achieved using various dissectio n techniques during proximal gastric vagotomy. The test is a useful, r eproducible and simple intraoperative method for assessing the complet eness of denervation.